1134129836 NPI number — CENTERVILLE COMMUNITY AMBULANCE SERVICE, INC.

Table of content: (NPI 1134129836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134129836 NPI number — CENTERVILLE COMMUNITY AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERVILLE COMMUNITY AMBULANCE SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134129836
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 181
Provider Second Line Business Mailing Address:
800 MAIN
Provider Business Mailing Address City Name:
CENTERVILLE
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57014-0181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-563-2842
Provider Business Mailing Address Fax Number:
605-563-2804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 MAIN STREET
Provider Second Line Business Practice Location Address:
BOX 181
Provider Business Practice Location Address City Name:
CENTERVILLE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57014-0181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-563-2842
Provider Business Practice Location Address Fax Number:
605-563-2804
Provider Enumeration Date:
07/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PETERSEN
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SECRETARY - TREASURER/BILLING MANGR
Authorized Official Telephone Number:
605-563-2842

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  611 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4305151 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93812 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9000490 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9214848 . This is a "DAKOTACARE" identifier . This identifiers is of the category "OTHER".